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Single center experience in selective feticide in high-order multiple pregnancy: clinical and ethical issues

  • Giovanni Monni EMAIL logo , Tamara Illescas , Ambra Iuculano , Marcella Floris , Federica Mulas , Laurence B. McCullough , Frank A. Chervenak and Shari E. Gelber
Published/Copyright: January 17, 2015
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 44 Issue 2

Abstract

Objective: This paper describes the 20-year experience with selective feticide (SF) of high-order multiple quadruplet and higher pregnancies in a single center.

Methods: The paper describes protocols, procedures, management, outcomes, and ethical issues.

Results: SF was performed in 49 pregnancies with 244 fetuses, with median gestational age of 12+2 weeks. The initial number was nine (one case), eight (one case), seven (three cases), six (11 cases), five (eight cases), and four (27 cases). Nuchal translucency was utilized prior to the procedure starting in 1996. The technique was transabdominal ultrasound-guided and intrathoracic injection of potassium chloride. One pregnancy (with seven fetuses) was reduced to three, 42 to two, and four (starting with four fetuses) to singletons. There were ten pregnancy losses (20.4%). A decreasing trend in losses was evident over the 20-year time period: 7/23 (30.4%) from 1994 to 2004 down to 3/26 (11.5%) for 2004–2014. No chromosomal abnormalities were present in any of the survivors. The ethical issues focus on the justification of SF in high-order multifetal pregnancies.

Conclusion: In this series, pregnancy loss decreased with operator experience. Excellent outcomes can be achieved with the ethically justified use of feticide in high-order multiple pregnancies.

Keywords: Fetal reduction; high-order multiple pregnancy; selective feticide
Corresponding author: Giovanni Monni, Department of Obstetrics and Gynecology Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Ospedale Microcitemico via Jenner, 09121 Cagliari, Italy, Tel.: +39 070 6095546; Fax: +39 070 6095514, E-mail:

References

[1] Chescheir NC. Outcomes of multifetal pregnancy reductions. Clin Obstet Gynecol. 2004;47:134–45.10.1097/00003081-200403000-00017Search in Google Scholar

[2] de Mouzon J, Goossens V, Bhattacharya S, Castilla JA, Ferraretti AP, Korsak V, et al. Assisted reproductive technology in Europe, 2007: results generated from European registers by ESHRE. Hum Reprod. 2012;27:954–66.10.1093/humrep/des023Search in Google Scholar

[3] Pharoah PO. Risk of cerebral palsy in multiple pregnancies. Clin Perinatol. 2006;33:301–13.10.1016/j.clp.2006.03.017Search in Google Scholar

[4] Chervenak FA, McCullough LB. An ethically justified, practical approach to offering, recommending, performing, and referring for induced abortion and infanticide. Am J Obstet Gynecol. 2009;201:560.e1–6.10.1016/j.ajog.2009.05.057Search in Google Scholar

[5] McCormick R. Ambiguity in moral choice. Milwaukee: Marquette University Press; 1977.Search in Google Scholar

[6] Chervenak FA, McCullough LB. The professional responsibility model of perinatal ethics. J Perinat Med. 2013;41:61–4.Search in Google Scholar

[7] McCullough LB, Chervenak FA. Ethics in obstetrics and gynecology. New York: Oxford University Press; 1994.Search in Google Scholar

[8] Monni G, Zoppi MA, Cau G, Lai R, Baldi M. Importance of nuchal translucency measurement in multifetal pregnancy reduction. Ultrasound Obstet Gynecol. 1999;13:377–8.Search in Google Scholar

[9] Stone J, Ferrara L, Kamrath J, Getrajdman J, Berkowitz R, Moshier E, et al. Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR). Am J Obstet Gynecol. 2008;199:406.e1–4.10.1016/j.ajog.2008.06.017Search in Google Scholar

[10] Monteagudo A, Timor-Tristch IE. An approach to multifetal pregnancy reduction in a pregnancy of grand order (12 fetuses). Ultrasound Obstet Gynecol. 1994;1:339–41.10.1046/j.1469-0705.1994.04040339.xSearch in Google Scholar

[11] Evans MI, Andriole S, Britt DW. Fetal reduction: 25 years’ experience. Fetal Diagn Ther. 2014;35:69–82.10.1159/000357974Search in Google Scholar

[12] Athanasiadis AP, Karavida A, Tzitzimikas S, Vavilis D, Grimbizis G, Tarlatzis BC, et al. Fetal reduction in a nontuplet pregnancy: technical and ethical considerations. Eur J Obstet Gynecol Reprod Biol. 2005;120:227–9.10.1016/j.ejogrb.2004.11.017Search in Google Scholar

[13] Evans MI, Berkowitz RL, Wapner RJ, Carpenter RJ, Goldberg JD, Ayoub MA, et al. Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol. 2001;184:97–103.10.1067/mob.2001.108074Search in Google Scholar

[14] Grau P, Robinson L, Tabsh K, Crandall BF. Elevated maternal serum alpha-fetoprotein and amniotic fluid alpha-fetoprotein alter multifetal pregnancy reduction. Obstet Gynecol. 1990;76:1042–5.Search in Google Scholar

[15] Lynch L, Berkowitz RL. Maternal serum alpha-fetoprotein and coagulation profiles alter multifetal pregnancy reduction. Am J Obstet Gynecol. 1993;169:987–90.10.1016/0002-9378(93)90040-PSearch in Google Scholar

[16] Lipitz S, Shulman A, Achiron R, Zalel Y, Seidman DS. A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening. Ultrasound Obstet Gynecol. 2001;18:35–8.10.1046/j.1469-0705.2001.00431.xSearch in Google Scholar PubMed

[17] Elliott JP. High-order multiple gestations. Semin Perinatol. 2005;29:305–11.10.1053/j.semperi.2005.08.001Search in Google Scholar PubMed

[18] Eddleman KA, Stone JL, Lynch L, Berkowitz RL. Chorionic villus sampling before multifetal pregnancy reduction. Am J Obstet Gynecol. 2000;183:1078–81.10.1067/mob.2000.108868Search in Google Scholar PubMed

[19] Brambati B, Tului L, Baldi M, Guercilena S. Genetic analysis prior to selective fetal reduction in multiple pregnancy. Technical aspects and clinical outcome. Hum Reprod. 1995;10: 818–25.10.1093/oxfordjournals.humrep.a136046Search in Google Scholar PubMed

[20] Dodd J, Crowther C. Multifetal pregnancy reduction of triplet and higher-order multiple pregnancies to twins. Fertil Steril. 2004;81:1420–2.10.1016/j.fertnstert.2003.11.028Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-11-6
Accepted: 2014-12-15
Published Online: 2015-1-17
Published in Print: 2016-3-1

©2016 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Current topics on ultrasound in perinatology
  4. Recommendation and Guidelines for Perinatal Practice
  5. Ultrasound in Africa: what can really be done?
  6. 3D/4D sonography – any safety problem
  7. Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach
  8. Academy’s Corner
  9. Sonoembryology by 3D HDlive silhouette ultrasound – what is added by the “see-through fashion”?
  10. Original articles – Obstetrics
  11. How effective is ultrasound-based screening for trisomy 18 without the addition of biochemistry at the time of late first trimester?
  12. Single center experience in selective feticide in high-order multiple pregnancy: clinical and ethical issues
  13. Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis
  14. Birth weight-related percentiles of brain ventricular system as a tool for assessment of posthemorrhagic hydrocephalus and ventricular enlargement
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  16. Original articles – Fetus
  17. Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death
  18. First trimester severe ductus venosus flow abnormalities in isolation or combination with other markers of aneuploidy and fetal anomalies
  19. Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile
  20. Does ethnicity have an effect on fetal behavior? A comparison of Asian and Caucasian populations
  21. Accuracy of ultrasound in estimating fetal weight and growth discordancy in triplet pregnancies
  22. Fetal nasal bone length in the second trimester: comparison between population groups from different ethnic origins
  23. Pregnancy outcome and long-term follow-up of fetuses with isolated increased NT: a retrospective cohort study
  24. Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study
  25. Opinion paper
  26. Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance
  27. Congress Calendar
  28. Congress Calendar
https://doi.org/10.1515/jpm-2014-0340
Keywords for this article
Fetal reduction; high-order multiple pregnancy; selective feticide

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Current topics on ultrasound in perinatology
  4. Recommendation and Guidelines for Perinatal Practice
  5. Ultrasound in Africa: what can really be done?
  6. 3D/4D sonography – any safety problem
  7. Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach
  8. Academy’s Corner
  9. Sonoembryology by 3D HDlive silhouette ultrasound – what is added by the “see-through fashion”?
  10. Original articles – Obstetrics
  11. How effective is ultrasound-based screening for trisomy 18 without the addition of biochemistry at the time of late first trimester?
  12. Single center experience in selective feticide in high-order multiple pregnancy: clinical and ethical issues
  13. Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis
  14. Birth weight-related percentiles of brain ventricular system as a tool for assessment of posthemorrhagic hydrocephalus and ventricular enlargement
  15. First trimester erythropoietin (EPO) serum concentration as a potential marker for abnormal placentation disorders. Reference values for erythropoietin (EPO) concentration at 11–13+6 weeks of gestation
  16. Original articles – Fetus
  17. Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death
  18. First trimester severe ductus venosus flow abnormalities in isolation or combination with other markers of aneuploidy and fetal anomalies
  19. Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile
  20. Does ethnicity have an effect on fetal behavior? A comparison of Asian and Caucasian populations
  21. Accuracy of ultrasound in estimating fetal weight and growth discordancy in triplet pregnancies
  22. Fetal nasal bone length in the second trimester: comparison between population groups from different ethnic origins
  23. Pregnancy outcome and long-term follow-up of fetuses with isolated increased NT: a retrospective cohort study
  24. Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study
  25. Opinion paper
  26. Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance
  27. Congress Calendar
  28. Congress Calendar
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